UK vs US vs Germany: Working as a Doctor Abroad with Dr. Dan Levi

We're very happy to welcome back Dr. Dan Levi to the AMBOSS Podcast! Since our last interview with him, he has switched from working as a physician in Germany to become a trainee in family medicine in the UK! Since he scored in the top 15 percentiles of the USMLE Step 1, Step 2, and the MSRA in the UK, he shared some of his study secrets with us plus his advice about mentoring and life as a doctor.

Fun Fact:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272460
https://pubmed.ncbi.nlm.nih.gov/21211793/
https://www.nature.com/articles/nrn2298
https://pubmed.ncbi.nlm.nih.gov/21417955/
https://pubmed.ncbi.nlm.nih.gov/22213750/ 

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Transcript

Sophie 0:22

Welcome to the AMBOSS Podcast Beyond the Textbook, where we provide medical students and physicians with in depth insights and expert knowledge that goes beyond your traditional medical textbooks. I'm Sophie Neal and today we're joined by one of our previous AMBOSSians, Dr. Dan Levy. Dan has studied medicine in Romania, and while there he's also completed his Step one and two. He actually made it to the top 15 percentile in both exams. And has gone on to also train as a doctor in the UK. So he's kindly agreed to share some of his study secrets with us If you caught our previous episode with Dan, you'll know that he also lived in Germany, where we originally met at AMBOSS, as he was an integral part of our USMLE expertise team He also practiced medicine in Germany for about two years before moving to the UK, Thank you so much for being here today, Dan. You've been very busy.

Dan 1:11

Thank you so much for having me.

Sophie 1:13

So you've decided to practice medicine in Europe and the UK, but you also studied for the US MLE to practice in the US, tell us a bit more about that.

Dan 1:23

So I was on the highway to the U. S. residency I finished step one and step two, and I was about to go to the U. S. to do my residency there. And then my Best friend Louisa, who is a artist in the Romanian mountains. she said drop everything Let's take a break. Let's go to Southeast Asia for about a month. And I found myself volunteering as a doctor in a Buddhist medical complex in Myanmar, And while I was there with the monks, they told me that I can go to a meditation retreat. And, you know, I took this 12 hour bus going through roads that I don't even know their names, and we got to a mountain that doesn't have a name, and we meditated there with the monks, and I reflected a lot about my decision to go to the U. S., and every time I would close my eyes and breathe deeply, I Understood that I doubt my motives, and I could always imagine my time in Germany with my friends in Europe and staying close to my family. And almost with this, I would say, rather impulsive decision, I decided to go to Germany. So a day afterwards, when I had this realization, I was already flying away from Myanmar. A week afterwards, I got the German visa. And then 10 months afterwards, I started practicing medicine in Germany and the rest is history.

Sophie 2:46

that's absolutely incredible. And Something that I don't assume a lot of medical Students get that chance you know,

Dan 2:53

to think,

Sophie 2:54

stop and think, you know, it's such a fast paced life and learning so much all the time and trying to make it to your goal, to actually be able to stop and think. and reroute. I think that's really a privilege and also very brave as well.

Dan 3:08

very much.

Sophie 3:10

So you decided not to go to the US, you decided to go to Germany, but then you decided to go to the UK. So why the UK instead of the US?

Dan 3:19

That's a very good question, why the UK instead of the U. S. so the first factor would be the speciality itself. At this point, I decided to go into family medicine. I had the vision of being part of my community and connected to the community and continuity of care. I love knowing my patients. And it took me really three years of, very difficult internal conflicts to be able to say, I want to do family medicine and not stay in the hospital. So from reading and listening to stories about people who did family medicine in the US and the UK, I got this vague And I'm saying vague because it's not my personal experience. I never trained in the U S. So it's just from what people told me that training in the UK as a family physician, what we call in England, the GP, general practitioner could fit my needs much better. So the way that it's built, the different rotations, the length of training is also equal between the countries, which is something which is absolutely not the case regarding other specialities. So which speciality you're going to go for played? a very important part in this decision making process. Now, My chances of receiving one of the best training spots in the UK back then was very high. I knew that I can score high in exams without fail and I knew that I could make it. Now standing from where I am, I wouldn't make the decision again because it wouldn't be as easy to enter the specialty in the UK. But I saw that I have this And I knew that if I'm going to act relatively fast, then I would be able to make it. the GPs or family physicians of the UK are in a very prestigious position, given the global shortage of GPs So one can transition relatively smoothly into Australia, Canada, New Zealand, and even the US a UK graduate for family medicine can now move there and practice medicine as long as you have the USMLE, On top of all of that, I, Had a mentor that helped me. He's a UK based colleague. He's also a family physician trainee from Cambridge. His name is Daniel Evan, and speaking with him, you know, throughout this process gave me this great clarity and much needed support regarding it. What I want to do and how to do it. And now that I'm here in Cambridge and we're in the same city, he still supports me on a weekly basis. And I cannot emphasize how much progression this gives to my personal and professional life.

Sophie 6:02

I think that's really excellent I think this is something really important for medical students to learn more about if they don't have a mentor. So maybe you can tell us more about this and how you're able to find great people to give you that advice and to guide you.

Dan 6:15

you. Right. So mentors are really everything in medicine, in my opinion, and also in life. So mentor's role in your life is to understand how you tick and function, and they see that throughout your progression, because usually they stay with you for a very long period, right? And then they apply their experience and expertise into your life. And in this way, instead of walking in the dark and bumping into walls for a very long duration, you just have this bridge that they built, and you can cross the bridge instead of making all of those mistakes and errors that cost a lot of time and effort. Specifically, mentors in the medical fields are important because medicine Medicine is much more of a craft than many other professions. In my personal opinion, medicine is this field where your personality and personal life often very much intertwined and are interwoven very deeply with your job as a doctor, and therefore you need someone to help you to make order and how to find this gentle balance in your life, which is truly not easy as a doctor, I think. I find that mentors are usually created when there is a deep, need. Usually, there is a dissonance between what should happen and reality that produces difficulties. So at that point, there is a dissonance, right, between the reality and the expectations. And from that dissonance comes the need to have a mentor. So to discover a mentor, you're basically looking for someone that reached a status in life that you wish to reach. But it's not only that. This person managed to do it fashion that you deem admirable. to recruit the mentor, you need to be very vulnerable. You need to present yourself in this open space. And to come and to be able to say, I'm lost. you need to do that in an elegant manner. You need for them to understand why and how you're lost. What are the pieces in play, so they could shift the pieces and rearrange them in a way that would give you the solution. And you need to help them see the purpose that you have in your mind and in yourself and to believe in it.

Sophie 8:34

Amazing. I think that's also some really excellent advice. And something that it sounds like you're already paying forward. as a mentor So you scored in the top 15 percentile in Step 1 and Step 2, and also in the top 15 percentile in the MSRA multi specialty Recruitment Assessment in the UK. So how did you do it, how can others do it? I'm sure people are dying to hear your tips.

Dan 8:57

So the entire mindset and starting schedule that we built when I was a U. S. M. L. E. Advisor in Ambrose with my team that had an expertise in the U. S. M. L. E. Field, I would argue is bulletproof. simply copied the approach and mindset that we had in AMBOSS for the USMLE to the MSRA, and it functioned fantastically. It was just great. It was simple. It was easy. You know, in my time in AMBOSS, my team received people that had predictors of 230s, and then we took them to the 250s plus, and I saw people who failed the steps, and then we took them to a match. So I just used that approach, and it was fantastic. No, The MSRA resources are in comparison to AMBOSS, I would say, very superficial. So that means that if you have a topic, let's say a neurological disease or COPD, it doesn't matter. Then 80 percent of All of the questions you would be able to answer with the MSRA resources, but then there are those 20 percent questions that are just very difficult and challenging. And what happens with those 20%? So using the ambos library and our ambos USMLE methodology just allowed me to crack them open, to answer them correctly. I also felt that I could reach information that I need much faster than others. You need to take that in the context that I had a full blown job as a doctor, right? Like I was doing a set of nights before I took the exam and the fact that I could access information so fast was a great advantage. So in AMBOSS you have those tables and summaries of the material in a high yield form, which is absolutely phenomenal because they give you this kind of life hack where somebody already hacked the exam, understood what information you need. In order to ace the exam and then present it for you in such an easy to digest format, and then you have those 20 percent questions that you constantly do correctly. And if you don't do them correctly, then you have to stable that you can access and then answer them correctly I also use AMBOSS in my daily life as a doctor, which prepared me for the exam especially on nights. We were a team in my former hospital of three doctors and a night practitioner and we cover about 300, 400 patients, right? And I use AMBOSS to troubleshoot problems that I cannot solve on the spot. I mean. This is a real scenario that happened to me. It's 3 a. m., right? I'm exhausted. There's a new patient with atrial fibrillation, new onset, never had it before, never had any cardiac issue. Supposedly, it's driven by his pneumonia. But he's deteriorating in front of me. He doesn't respond to his antibiotic. He doesn't respond to the escalated antibiotic. Digoxin and beta blockers do not do the job. This person is on the verge of death. I call their family at 3 a. m. I tell them, you need to come in, he might die. I have at least 30 other patients to see that are deteriorating. This patient have former x rays and everybody always interpreted them as pneumonia. And I just don't know what to do, I'm too tired to think, I'm too stressed to think. I open AMBOSS, I write this plan, and it just gives me this short summary of what to check and what to do in a checklist. And I go through it, and very fast I see that I missed that this person is having bulging neck veins, and then very quickly I understand that he has this mixed picture of pneumonia, but also pulmonary congestion. We give him diuretic and in 30 minutes is breathing peacefully. He fell asleep and we saved his life. Now, of course, if you're already on the job for two years or one year, even, or three years, then you get accustomed to it. But The fact that you need to handle so many patients with so many different pathologies, you need something that can help you. Now, the thing with the AMBOSS platform is that it also gives you the rationale in a very easy to digest manner. So just going with AMBOSS through my daily life as a doctor really prepared me for the exam as well. I think it helped me a lot in achieving that score.

Sophie 13:16

wow, amazing and so cool to hear how transferable it's been for you, you know, practicing. medicine in different countries, studying exams in different countries, but you've been able to rely on it as a resource. I'm super happy. to Hear that?

Dan 13:28

I was, also surprised because you, you know, initially you use it just for the U-S-M-L-E exam, but then when I moved to Germany, everybody use it there. And now in England, they also use it on a daily base. And that's just amazing. And it happened to me in the night shifts as well, that we have patients and the team just doesn't know what to do. And then I opened the amus app and afterwards the team just asked me, what, what is it that you use? Like, what's the name and Amboss is just a fantastic product. And I say it without, I don't have any stock, right? Amboss is just, you could see that it's a platform that was done by doctors for doctors, and I just truly stand behind it because it's a fantastic product.

Sophie 14:04

Yeah, I mean, it was really interesting for me to listen to you describe it in real life situations. not necessarily that you don't know the information, but when you're treating so many patients and you're so tired, like just to have a comprehensive checklist that you can run through. And even something to just mentally calm you down, that you've got something to help you there, you know, to help you make the right decisions. I think is is amazing.

Dan 14:27

Yeah, definitely. 100%.

Sophie 14:29

Very cool. Well, I would like to know, what was it like transitioning from practicing medicine in German to practicing in English in the UK? That must have been quite a change for you.

Dan 14:40

That was a big change especially the language being involved which enabled me to have a much better access and genuine human connection with my patients and with my colleagues. In Germany, I practiced in three different hospitals, but all of them were very small. And in the UK, until now, I have practiced only in one district hospital. So hospitals are not like a chain, right? You cannot just go to one and the other and expect to have the same product and the same vibe and the same things as in the other hospital. Every hospital has its own set of regulation, laws and rules, and therefore everything that I say is truly from my personal experience, and it's not a generalization of the entire country. So practicing medicine in Germany was very pure in a sense. It's very straightforward. You follow your own experience and the experience of your superiors, and the guidelines are there to help you, not to dictate your next movements. And documentation is very medical oriented, medicine oriented, and not extensive or exaggerated. But In Germany, they also have this tendency to throw you relatively very fast into very deep waters. So that means that you get an entire section of patients department and you don't necessarily have so much senior support again depends on which hospital you are and well, but with this responsibility and freedom of movement, you also And I think that's really important. grow very fast, but in a very brutal way. In England, in contrast, doing medicine is somewhat much slower. It is a specialist led, we call the specialists in England consultants, and as a trainee, you're functioning more as the executor of those plans. So the plan is being made by the senior doctor. And then you just execute it. All together in the UK, you have much less freedom of movement and practice than in Germany. But I also found myself in Germany many times in situation where The burden of making the decision was unbearable. It was too much for my experience back then. in the UK, this happened relatively less because you do have, I would argue, more senior support. the UK is also very different than Germany in the sense that we do a lot of protective medicine. Documentation is very extensive. There's a lot of paperwork and there are many more regulations and laws than in Germany. The important thing to remember, though, is that the two systems are very different, right? The model upon which they operate is very different. The NHS is completely different animal than the German one.

Sophie 17:26

Yeah, no, absolutely. I mean, for me, it's really a very interesting topic because I, I'm from the UK, but I live in Germany. and so I've experienced. both healthcare systems as a patient, and, you know, being in Germany where you have this sort of dual system where you can access private care, In a way, you know, in comparison to the NHS where you do have to wait for a long time to see specialists if it's not an emergency, but then they have excellent emergency care, you know, it's just very different, but definitely a topic I think we could talk about in another episode, but I wanted to ask you as well, Do you think you might move again? You know, where would you like to practice medicine in the future?

Dan 18:04

question that I yet. I think that in this rapidly shifting and changing medical universe, it would almost be arrogant and ignorant to say that they already know eventually that there are many factors that contribute to this equation. And without shame, I would say that as I become, More mature, I'm currently 32, and experience life. I also change, a lot. My priorities change and shift, and what I want change and shift. And I'm currently in this very lucky position where I have three, four more years of training, and only then I have to decide. So for now, I'm more than content with letting life unfold while I keep a very vigilant mindset.

Sophie 18:49

Yeah, absolutely, I think. As you grow and age and your situation changes, as you said, you want something needs change, So that is a really, tricky question, Definitely a difficult one to answer when you can't always predict the future. And I think it's good not to always have a very, very definite plan and change with those changes. Well, Dan, you've given us some absolutely brilliant nuggets of advice, And I'm really, really happy that you were able to take the time to join us, given that you're so busy, but I do have to ask you one more really important question. if you could give our listeners any advice beyond the textbook, what would you say?

Dan 19:24

um, Dr. Evan actually did this thinking experiment, with me when I wasn't sure which speciality to choose, the thinking experiment goes like this. You imagine that you're dead, right? You are at your own funeral. And now comes your spouse or parent or child, and they speak about you. And they will say three things that you are. What do you want those three things to be? And for me, I was shocked to discover what was going in my mind. I always had this image of myself as a doctor in a massive hospital doing research, But then something didn't, there was a dissonance between what my brain wanted and The feeling that I have as I was going forward in this plan, and then when I've done this thinking experiment, I discovered that what I wanted is to be remembered as a trusted physician by my patient. And to have a very good connection to them. I wanted everybody to know that I love to hike and that I'm mindful. And that I'm a simple man who does simple things, but with great intensity and pleasure. And that was kind of, you know, I was sitting on the fence regarding to stay in hospital or to go to be a GP for a very long duration. I would even say one year, one year and a half. And doing that thinking experiment was the push that I needed in order to get me to where I am right now, and I'm very happy about it.

Sophie 20:59

Thank you, Dan. That's really, really helpful. A lovely way to end the episode, thank you so much, Dan. I'm so happy you could be here. I'm so happy I got to chat with you again. I'm always so impressed with the advice that you've got to share which is why we really wants to have you on the podcast again. So thank you so much for being here.

Dan 21:16

I really enjoyed it. And

Sophie 21:19

Well, finally, we'd like to leave you with a medical fun fact along the theme of studying something that might sound a bit self explanatory, but I think also something really important to remember. taking breaks and incorporating physical activity can enhance your learning. Research has shown that short breaks during study sessions can help improve focus and retention. engaging in moderate exercise like a short walk has been linked to increased cognitive function and better academic performance. So the next time you're feeling a bit overwhelmed with studying, consider taking a short break and incorporating some physical activity to refresh your mind. And that's it for today's episode of the AMBOSS podcast, Beyond the Textbook. Thank you all for listening and we hope that it's given you some great insights when it comes to exam preparation, Scoring higher with AMBOSS and using it wherever you're practicing medicine, as well as some excellent advice when it comes to studying and practicing internationally. Be sure to subscribe to our podcast for more exciting episodes covering everything in health care and medical education. And please don't forget to leave us a great five star review. Take care, everyone. This has been Sophie Neal and Dr. Tana Schrank with Dr. Dan Levy. And this is AMBOSS Beyond the Textbook.